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          <h1 class="post-title" itemprop="name headline">口腔影像学——图像的解释2：根尖周病</h1>
        

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        <p>读书笔记，感谢作者。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/01.jpg"><br>根尖周组织的影像学图像解释<br>正常影像<br>根尖周组织的正常解剖结构<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/02.jpg"><br>恒牙的根尖周组织<br>最重要的是三个特征：①代表了牙周膜间隙的透射线，形成一个薄的连续的黑线环绕在牙根周围；②代表了牙槽骨皮质骨的阻射线，形成一个薄的，连续的白色线与黑线相邻。③周围牙槽骨的骨小梁模式和密度：a)在下颌，骨小梁倾向于较厚并且聚集在一起，经常水平排列；b)在上颌，骨小梁倾向于更广泛的分布。没有主导性的排列模式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/03.jpg"><br>乳牙的根尖周组织：<br>①其下方有恒牙和牙胚的存在，其图像可能覆盖了乳牙的根尖；②乳牙正常脱落过程中存在牙根吸收。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/04.jpg"><br>年轻恒牙的根尖周组织<br>①根尖区域的透射影像；②环绕龈乳头的完整的硬骨板的阻射线；③发育中的根尖孔是喇叭口状的；④只有在牙根发育完全后，薄的连续的透射线才出现。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/05.jpg"><br>正常解剖结构在根尖片上的重叠投影：<br>透射性阴影<br>包括：①上颌窦；②鼻腭孔；③神经孔(The mental foramina)。<br>影像：①牙周膜间隙的透射影像透射度会增大，或者范围变宽，但仍是连续的，可以很好的分界；②硬骨板的阻射线会减弱，也许会不可见；③在牙槽骨上会在根尖区有透射影像。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/06.jpg"><br>阻射性阴影<br>包括：①下颌舌骨脊；②颧骨体；③骨硬化区域（Areas of sclerotic bone），也叫密质骨岛(dense bone islands）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/07.jpg"><br>根尖周炎症的影像学表现<br>总结如下表<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/08.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/09.jpg"></p>
<p>A:正常根尖  B:早期根尖改变，根尖周牙周膜间隙增宽 C:早期根尖改变，硬骨板阻射区丧失<br>D:急性炎症的广泛性破坏，界限不清 E:长期存在的慢性炎症：界限清晰的密质骨包绕的透射区（根尖周肉芽肿或根尖囊肿） F:早期慢性炎症——根尖区界限模糊的阻射区域(致密性骨炎)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/10.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/11.jpg"></p>
<p>看根尖周疾病影像的系统化流程<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0022-kqyxx-txjs-gjzb/12.jpg"><br>总体浏览整个图像<br>①.了解患者病情发展的时间和先后顺序。<br>②.了解患牙范围内的任何正常的解剖结构投影的位置，轮廓，密度。<br>检查并评估影像上的每一颗牙齿<br>③牙冠<br>特别留意：是否存在龋坏，已有充填体的状态。<br>④牙根<br>特别留意：牙根长度、数量、形态、根管大小和形态、是否存在一些特殊情况（髓石、根管充填影像、根管内充填物、根管外充填物、根裂）。<br>⑤根尖组织<br>特别留意：以下组织的完整性、连续性以及厚度：a.牙周膜间隙的透射影像；b.硬骨板的阻射影像。任何相关的透射区域和阻射区域。骨小梁的排列模式。<br>⑥牙周组织<br>特别留意：牙周膜间隙的宽度，牙槽嵴的水平和质量，任何垂直和水平的骨丧失，任何牙石沉积，任何相关的牙根分歧分叉。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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